Cervical Cancer Screening Should Continue after 65

A new study suggests that women without a hysterectomy and women over 65 who have not been recently screened may benefit from continued surveillance for cervical cancer (CC).

Researchers at the U.S. Centers for Disease Control and Prevention conducted a study that examined recent CC incidence data from the U.S. 2013 and 2015 National Health Interview Survey (NHIS) federal cancer surveillance programs for all women by age and race, corrected for hysterectomy status. They then calculated the proportion of women aged 41–70 years without a hysterectomy who reported that they never had a Papanicolaou (Pap) test or that their most recent Pap test was at least five years previously.

The results revealed that when corrected for hysterectomy, incidence rates of CC increased with age until 70 years, and did not begin to decline until age 85. In addition, many women approaching the accepted "stopping" age of 65 were not getting sufficient screening, and that the proportion of women not recently screened increases with age. While only 12% of women in their 40s had no recent screening history, that number progressively increased for women in their 50s and 60s. Nearly 850,000 women aged 61-65 years had not been screened within the last five years. The study was published on May 1, 2017, in the American Journal of Preventive Medicine.

“A recommended upper age limit for routine screening may lead women and providers to assume that cervical cancer is a younger women's disease. After adjustment for hysterectomy, some of the highest cervical cancer incidence rates occur among women older than 65 years, with notably higher rates among older black women,” said lead author epidemiologist Mary White, ScD, of the Division of Cancer Prevention and Control at the CDC. “Women who have not had a hysterectomy need to continue to be screened until age 65, and possibly later if they have not been screened for many years or are at special risk.

Cervical cancer arises from the cervix; it typically develops from precancerous changes over 10-20 years. Symptoms may include abnormal vaginal bleeding, pelvic pain, or pain during sexual intercourse. Human papillomavirus (HPV) infection causes more than 90% of cases, with other risk factors include smoking, a weak immune system, birth control pills, many sexual partners, and starting sex at a young age. CC diagnosis is typically by cervical screening followed by a biopsy.